Prostate-specific Antigen Screening Research Articles

Multidimensional Healthcare Access Barriers to Prostate-Specific Antigen Testing: A Nation-Wide Panel Study in the United States From 2006 to 2020.

Rising metastatic prostate cancer incidence has renewed debate regarding benefits of prostate-specific antigen (PSA) screening. Identifying barriers to accessing screening for individuals at high risk of lethal prostate cancer may slow this rise. We examined associations of access barriers with receipt of PSA testing, stratified by sociodemographic factors. We pooled data from male respondents to Behavior Risk Factor Surveillance Systems (BRFSS) surveys from 2006 to 2020. Questions related to affordability (insurance, cost of visits) and accommodation (regular primary care provider (PCP), physician recommending a PSA test) were considered as individual-level barriers. For availability, we linked provider density from the 2012 Area Health Resource File and estimated driving times to closest health facility within Micropolitan and Metropolitan Statistical Area (MMSA) using Google Earth Engine. These measures were used to compute a spatial accessibility index. We fit survey-weighted, covariate-adjusted logistic regression models to estimate associations of barriers with receipt of PSA within the past 2 years and examined effect modification by sociodemographic factors. There were 185,643 participants, of whom 73% were White, 11% were Black, 4% were Asian, and 11% were Hispanic. Physician recommendation was the strongest predictor of having a PSA test (aOR: 14.5, 95% CI: 13.6, 15.6). Not having a regular PCP (aOR: 0.29, 95% CI: 0.27, 0.31), insurance (aOR: 0.64, 95% CI: 0.58, 0.71), and prohibitive cost of care (aOR: 0.82, 95% CI: 0.75, 0.90) were associated with lower PSA testing. Access barriers were stronger predictors of PSA testing for Asian and White participants compared to other groups (Phet < 0.004 for insurance and regular PCP) and for those with college education compared to those without (Phet < 0.05 for insurance, perceived unaffordability). Physician recommendation was the strongest predictor of receipt of PSA testing, regardless of sociodemographic grouping. Future studies should consider access barriers jointly and across sociodemographic strata.

Breast and Prostate Cancer Screening by Life Expectancy in Patients with Kidney Failure on Dialysis.

The Choosing Wisely campaign suggests an individualized approach to cancer screening among patients receiving dialysis. We aimed to evaluate breast and prostate cancer screening among patients receiving maintenance hemodialysis (HD) by kidney transplant waitlist status and five-year survival probability. We conducted a retrospective cohort study using a nationally representative population of HD patients. Patients receiving HD each calendar year from 2003-2018, ≥1 year of Medicare as the Primary Payer, and age 50-69 years were included. The cohort was split into prognosis and cancer screening sets. Models of five-year survival were built in the prognosis set using logistic regression. Five-year survival probabilities were generated in the cancer screening set, excluding patients with prior breast or prostate cancer, and screening over the next year was assessed. 160,537 patients contributed 356,165 person-years to the cancer screening set (59% of the person-years were contributed by males, median age was 60 years). Compared to a benchmark rate of 50% (e.g., mammography every other year), 42% of waitlisted female-years were screened by mammography. Overall, 17% of non-waitlisted female-years were screened (20% among those with >50% probability of five-year survival and 8% among those with <10% probability of five-year survival). Compared to a benchmark rate of 20% [e.g., serum prostate-specific antigen (PSA) screening up to five years apart], 24% of waitlisted male-years were screened with serum PSA. Overall 15% of non-waitlisted male-years were screened (13% among those with >50% probability of five-year survival and 1% among those with <10% probability of five-year survival). Patterns were similar after age-standardization. Patients with higher predicted survival have higher rates of cancer screening, suggesting providers consider life expectancy. However, non-waitlisted patients with high probability of five-year survival were less likely to be screened compared to waitlisted patients. Interventions may be needed to close this screening gap.

Investigating the pattern of prostate specific antigen screening among E-cigarette smokers within the behavioral risk factor surveillance system

Introduction and objectivesE-cigarettes use has recently increased, even among older individuals quitting smoking. Though past studies suggest tobacco smokers may avoid cancer screening, the relationship between e-cigarette uses and preventive health behaviors like prostate specific antigen screening is uncertain. We assessed the relationship between self-reported e-cigarette smoking and prostate specific antigen screening utilization among US adults with a history of e-cigarette use. Materials and methodsWe included men aged 50–69 years, who provided responses regarding PSA screening receipt and smoking status, from Behavioral Risk Factor Surveillance System 2020 and 2022 surveys. Primary outcome was PSA screening receipt. Multivariable regression model was performed to investigate the association between smoking status (never-smokers, current or former e-cigarette smokers, current or former tobacco smokers) and PSA screening. ResultsWe included a weighted population of 8.1 million men aged 50–69. 2.3 million (28.3%) received PSA screening. 3.9 million (48.2%) were never-smokers. 1.3 million (16.6%) were from e-cigarettes smokers group, and 2.9 million (35.2%) were from tobacco smokers group. E-cigarettes smokers were less likely to receive PSA screening within last 2 years (0.76 [0.66–0.88]) than never-smokers. No significant difference in PSA screening was detected between never-smokers and tobacco smokers (0.91 [0.82–1.02]). E-cigarette smokers were less likely to receive PSA screening within the selected time frame (0.84 [0.72–0.97]) than tobacco smokers. When examining potential mediation by primary care visits, e-cigarette smokers were less likely to have had a check-up visit in past 2 years than tobacco smokers (0.77 [0.65–0.92]). ConclusionsE-cigarette smokers were less likely to undergo PSA screening than never-smokers and tobacco smokers, possibly due to reduced use of primary care services.

Abstract A134: Overcoming barriers to prostate cancer screening: A tethered educational video and mobile screening program

Abstract Background: Prostate cancer (PC) is the most commonly diagnosed cancer in men. One in 8 White and 1 in 6 Black men will be diagnosed with PC in their lifetime. The current prostate cancer screening (PCS) guidelines recommend shared decision making to discuss the advantages and disadvantages of PCS. In Philadelphia, among men over 40 years of age, only 39% and 18% have discussed the advantages and disadvantages of PCS with a provider, respectively. Among men over 50 years of age, only 47% have had a Prostate Specific Antigen (PSA) test. This research evaluated an educational video designed to increase awareness of the advantages and disadvantages of PCS and provided access to mobile PSA screening among the diverse men in Philadelphia. Methods: Between April-May 2024, we enrolled men aged 40+ at community events within and around the city of Philadelphia and excluded men who previously participated in the study. Screening events were advertised through social media, printed flyers, emails, and text messages disseminated by labor union administrators to union members. Participants completed a questionnaire which examined PC and PCS knowledge, decisional conflict, and likelihood to screen before and after viewing a 12-minute educational video on an iPad or personal device. The video consisted of a conversation between a local pastor, who is a Black PC survivor, and a urologist. The video included the pastor’s personal experience with PC and allowed him and the urologist to have the opportunity to address common PC misconceptions and myths. After the video, participants provided video feedback. A $10 gift card and giveaways were offered before presenting the option for on-site PSA draws by a licensed phlebotomist. Results: A total of 133 men (38% Black; 56% White, 10% Hispanic; mean age of 53 years old (s.d.=10.4)) completed the pre and post questionnaires. A total of 61% of participants had never had a PSA test. Twenty-two percent did not know blood testing was an option, and 28% did not know they needed a PSA test. Thirty-two percent of participants would have been somewhat or very unlikely to get screened without this program. Having the screening option come to their community or place of work was the determining factor for 81% of screened participants. After watching the video, PC knowledge improved in 6 of 10 items (overall knowledge score pre vs. post p&amp;lt;.01). Post video, decisional conflict was reduced in 9 of the 10 questionnaire items (each item had a p≤.001). A total of 95% of participants stated ‘yes’, they would undergo PCS after watching the video versus 69% being either somewhat or very likely to get screened before watching the video (p&amp;lt;0.001). All 95% were screened on-site. The video information was deemed useful to 99% and credible by 97% of respondents. Conclusion: This educational video increased PCS awareness, intention to screen for PC, and completion of PCS. When coupled with an educational video, mobile PSA screening initiatives are an effective and efficient way to increase access to PSA screening for diverse men. Citation Format: Mallorie C. Jones, William Buckley, Alexandra Cordoba, Suji Kim, David Barreto, Debanjan Pain, Vivian Nguyen, Blane Newberry, Daniel Lee, Carmen E. Guerra. Overcoming barriers to prostate cancer screening: A tethered educational video and mobile screening program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A134.

Abstract C020: Nuclear encoded mitochondrial protein MAGMAS as a potential predictor of taxane sensitivity in advanced prostate cancer patients and differential diagnostic marker of tumor aggressiveness in men of African ancestry

Abstract Prostate cancer (PCa) is the most commonly diagnosed malignancy and the second leading cause of cancer-related death among men in the United States (U.S.). Strikingly, men of African ancestry (AA) are 1.7 times more likely to be diagnosed with PCa and more than twice as likely to die of PCa than men of European origin (EU). These disparities are driven by socioeconomic, lifestyle, environmental, and biological/genetic factors. Prostate-specific antigen screening is limited in identifying men with aggressive PCa and exposes men to increased harm with minimal reduction in mortality from PCa. Specifically, several studies report that men of AA are considered to have low-risk prostate cancer by clinical parameters, and those who enrolled in active surveillance programs progress to a higher Gleason-grade cancer and high-volume status than men of EA. Also, men of AA in low to moderate-risk groups appear to be at a higher risk for biochemical recurrence after curative-intent treatment. Therefore, there is a need to understand molecular mechanisms underlying PCa aggressiveness in men of AA that are translatable to the clinic as reliable biomarkers and for the development of novel therapeutic targets. Evidence supports that the mitochondria have a fundamental influence on all steps of oncogenesis, including malignant transformation, tumor progression, and treatment resistance. Regarding cancer health disparities, genes encoding mitochondrial complexes involved in oxidative phosphorylation are upregulated to a greater extent in tumor specimens from AA patients than those from EA patients, supporting the rationale for investigating the role of mitochondria in cancer health disparities. This study investigates Magmas, a nuclear-encoded mitochondrial protein, as a potential mitochondrial marker for PCa tumor aggressiveness and a therapeutic target for advanced PCa. Several observations support the rationale for this study: 1) Magmas overexpression in multiple aggressive cancer subtypes, including high-grade prostate, ovarian cancer, and malignant gliomas. 2) AA PCa cell line overexpresses Magmas similar to chemo-resistant PCa cells, whereas the EA cell line is shown to exhibit lower expression. 3) In human cells, overexpression of Magmas suppresses oxidative stress by regulating the reactive oxygen species (ROS) levels. 4) In chemo-resistant PCa cell lines, pharmacological inhibition of Magmas re-sensitized PCa cells to taxane treatment; and 5) non-cytotoxic pharmacological inhibition of Magmas in chemo-resistant PCa cells dramatically reduced clonogenicity potential. We will evaluate the hypothesis that AA PCa tissue will overexpress Magmas and that overexpression will predict tumor aggressiveness, and 2) that pharmacological inhibition of Magmas will overcome treatment resistance in advanced PCa models. The proposed exploratory study is highly relevant as it will reveal the biological basis for race-related differential expression of Magmas, providing critical insights into mitochondrial determinants that contribute to PCa mortality disparities. Citation Format: Alfonso Duran, Kristen Whitley, Krystal Santiago, Bhaskar Das, Carlos Casiano, Frankis Almaguel. Nuclear encoded mitochondrial protein MAGMAS as a potential predictor of taxane sensitivity in advanced prostate cancer patients and differential diagnostic marker of tumor aggressiveness in men of African ancestry [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C020.

Drugs causing prostate-specific antigen changes: the food and drug administration adverse event reporting system combined with Mendelian randomization analysis

ABSTRACT Background Prostate cancer is one of the most common malignancies in men worldwide, and prostate-specific antigen (PSA) screening is widely used for its early detection. Drug use may affect PSA levels, but the effect for most drugs is currently unknown. Methods This study first investigated drugs related to PSA changes through the Food and Drug Administration Adverse Event Reporting System (FAERs) database, and then used a Mendelian randomization (MR) method to explore the causal relationship between specific drugs and PSA changes using a genome-wide association study (GWAS) data. The statistical analysis software SAS and R were used in the study. Results Through analysis of the FAERs database, 22 drugs were found to be associated with an increase in PSA, and 14 drugs were associated with a decrease in PSA. MR analysis showed that the use of tamsulosin may lead to an increase in PSA. Heterogeneity test, horizontal pleiotropy test and leave-one-out Analysis verified the stability of the results. MR analyses for other drugs did not show statistical significance. Conclusion This study provided a basis for better understanding the impact of medications on prostate health, helping to avoid overdiagnosis or underdiagnosis of high-risk patients. However, research still requires larger-scale validation and in-depth exploration.

Abstract B041: Community-based prostate cancer screening for Black men

Abstract PURPOSE: The 5-year relative survival rate for men with prostate cancer (PC) is greater than 99% when diagnosed at an early stage. The prognosis is much worse for men diagnosed with advanced disease as there is no cure for metastatic PC. With the establishment of prostate- specific antigen (PSA) blood testing as an effective tool for early screening for PC, the prevention of morbidity and mortality from this disease proves possible. However, Black men are more likely to develop aggressive PC and die, yet less likely to be screened despite population-specific guidelines recommending shared decision-making for high-risk groups to begin at age 40. For these reasons, increasing the rate and reach of PSA screening within the community is an innovative approach to raise awareness and reduce mortality from PC for Black men. METHODS: Morehouse School of Medicine’s (MSM) Prostate Cancer Precision Prevention Program (PCP3) leverages community partnerships to provide point-of-care PSA testing at no cost to Black men in the greater Atlanta area and rural Georgia. Community-based screening events were initiated in June 2023 and have been conducted in collaboration churches, municipalities, and non-profit organizations. Participants were recruited at these events and consented to provide one tube of blood drawn by MSM phlebotomists and registered nurses for quantification of PSA levels. Results were processed through Morehouse Healthcare and participants were contacted with individual results and provided with options for follow-up. RESULTS: To date, PCP3 has conducted more than three dozen community-based screening events. Over 1000 Black men have received PSA testing with variable results. CONCLUSION: PCP3 has provided awareness and PSA testing to over 1000 Black men in Atlanta and rural Georgia at higher risk for aggressive and lethal PC. PCP3 aims to assess whether community- based screening reduces mortality from PC for Black men in Georgia over the next few years. Citation Format: Pam Cooper, Kitty Carter-Wicker, Eddie R. Stanley, Imani A. Boyd, Nicole Mavingire, Brian Rivers, K. S. Kimbro, Rick A. Kittles, Leanne Woods-Burnham. Community-based prostate cancer screening for Black men [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B041.

Abstract B084: Multi-Stakeholder Engagement to Create Equity in Prostate Cancer Outcomes through Identifying Community Priorities in Early Detection Research

Abstract Introduction: Black individuals have a two-fold higher rate of prostate cancer death in the US compared with other groups. This is the largest racial inequity in US cancer-related deaths. Annual prostate-specific antigen (PSA) testing among Black individuals starting at age 45 years could reduce mortality by 30% compared with current screening practices. Few current practice guidelines make race-conscious screening recommendations due to a lack of trial data on screening in Black populations; only 0-3% of participants in practice-informing PSA screening trial cohorts were Black. An equity-informed approach is required to ensure that trial designs reflect the priorities and perspectives of Black individuals to ensure their participation in future research. Methods: We partnered with the Black and African-descent Collaborative for Prostate Cancer ACtion (BACPAC) to conduct a survey to identify community priorities in prostate cancer early detection research. Respondents were asked to rate the importance of 15 research topics, then select the three topics most critical for research. Members of the BACPAC Virtual Research Community (VRC), a nationally representative group of 2,016 Black prostate cancer survivors and community members, were invited to participate. Eligible members were Black prostate cancer survivors and family members/caregivers of Black prostate cancer survivors. Those who met the inclusion criteria were emailed a unique link to complete the online survey. Results: 1,557 eligible VRC members received a survey link, 1,224 surveys were completed (78.6% response rate). 60% of respondents were survivors, 38% were family members/caregivers, and 2% were both. More than 80% of respondents rated each of the 15 research topics as moderately to very important. Topic rankings revealed two overarching priority areas, representing 6 out of 15 topics included in the survey. These areas were 1) the use of reflex testing in the setting of elevated PSA to aid detection of clinically significant cancer and 2) establishing optimal timing for initiation or interval of PSA testing for prostate cancer screening. Regarding use of reflex testing, 97.7% of respondents prioritized blood (44.3%), urine (27.8%), or MRI (25.6%) reflex testing. Regarding timing of PSA testing, 51.5% of respondents prioritized customized screening schedules based on personal risk factors, with 24.9% selecting to improve rates of screening and 26.6% selecting to improve detection of clinically significant cancers, and 25% of respondents prioritized initiating screening at age 45 to improve early detection of prostate cancer. Conclusion: Our survey identified critical research topics that are of high importance to Black prostate cancer survivors and their families/caregivers. Our findings bridge a critical gap in prostate cancer early detection research, from which Black individuals have been historically excluded. Involving Black prostate cancer survivors in research design may help ensure that Black individuals are better represented in future clinical trials. Citation Format: Jenney R. Lee, Sung Min Kim, Erika M. Wolff, Yohali Burrola-Mendez, Dante' Morehead, Ben Young, Raymond Miller, Robert Ginyard, Frank Fields, Marty Chakoian, Patrick Bingham, Daniel VanArsdale, Mike Crosby, Tony Minter, Thomas Farrington, John Masembe, Burcu Darst, Ruth Etzioni, Adam Murphy, Sam L Washington, Jonathan Shoag, Yaw A Nyame. Multi-Stakeholder Engagement to Create Equity in Prostate Cancer Outcomes through Identifying Community Priorities in Early Detection Research [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B084.

Health-seeking practices and prostate cancer screening decisions among black men in the United States, Nigeria, and Cameroon

Health-seeking practices are important for prostate cancer (CaP) screening and control. There is evidence of differences in the health practices of Black men (BM) worldwide; however, the comparison between BM’s health-seeking practices in the United States and those in Africa has not been fully elucidated. This study evaluates health-seeking practices and willingness to screen for CaP among BM in Nigeria, Cameroon, and their relatives in the United States. CaPTC family cohort study phase 1 data of 500 community-dwelling black men in Nigeria, Cameroon, and the United States 35 and 70 years were used. The association between health-seeking practices and willingness to screen for CaP was evaluated. The associations between health-seeking practices and the willingness to screen for CaP were evaluated. The majority (83.8%) reported no medical consultation in the last 12 months, and the country of residence did not improve physician visits (p= 0.378). Healthcare insurance coverage was more available to the United States participants (68.4%), 42.9% in Nigeria, and 16.7% in Cameroon. Overall willingness to screen, willingness for digital rectal examination, and prostate-specific antigen screening were significantly associated with the country of residence with p-values of 0.02, &lt;0.01, and &lt;0.01, respectively. United States participants showed more willingness to screen. Healthcare coverage was also associated with overall willingness to screen (p=0.033). The study showed that country of residence was not associated with physician consultation but was significantly associated with willingness for CaP screening and healthcare insurance coverage.

Prostate-specific antigen testing patterns and prostate cancer stage at diagnosis in older Ohio cancer patients.

Prostate cancer (PCa) screening recommendations do not support prostate-specific antigen (PSA) screening for older men. Such screening often occurs, however. It is, therefore, important to understand how frequently and among which subgroups screening occurs, and the extent of distant stage PCa diagnoses among screened older men. Using the 2014-2016 linked Ohio Cancer Incidence Surveillance System (OCISS) and Medicare administrative database, we identified men 68 and older diagnosed with PCa and categorized their PSA testing in the three years preceding diagnosis as screening or diagnostic. We conducted multivariable logistic regression analysis to identify correlates of screening PSA and to determine whether screening PSA is independently associated with distant stage disease. Our study population included 3034 patients (median age: 73years). 62.1% of PCa patients underwent at least one screening-based PSA in the three years preceding diagnosis. Older age (75-84years: aOR [95% CI]: 0.84 [0.71, 0.99], ≥ 85: aOR: 0.27 [0.19, 0.38]), and frailty (aOR: 0.51 [0.37, 0.71]) were associated with lower screening. Screening was associated with decreased odds of distant stage disease (aOR: 0.55 [0.42, 0.71]). However, older age (75-84years: aOR: 2.43 [1.82, 3.25], ≥ 85: aOR: 10.57 [7.05, 15.85]), frailty (aOR: 5.00 [2.78, 9.31]), and being separated or divorced (aOR: 1.64 [1.01, 2.60]) were associated with increased distant stage PCa. PSA screening in older men is common, though providers appear to curtail PSA screening as age and frailty increase. Screened older men are diagnosed at earlier stages, but the harms of screening cannot be assessed.

Early economic evaluation of magnetic resonance imaging for prostate cancer detection in primary care.

To explore the potential impacts of incorporating prebiopsy magnetic resonance imaging into primary care as a triage test within the prostate cancer diagnostic pathway. Decision analytic modelling with decision trees was utilised for this early economic evaluation. A conceptual model was developed reflecting the common primary care routes to diagnosis for prostate cancer: opportunistic, asymptomatic prostate-specific antigen (PSA) screening or symptomatic presentation. The use of multiparametric MRI (mpMRI) or biparametric MRI (bpMRI) as a primary care triage test following an elevated PSA result was evaluated. A health system perspective was adopted with a time horizon of 12 months. Health effects were expressed in terms of utilities drawn from the literature. The primary outcome was prostate cancer diagnosis. Evidence used to inform the model was drawn from published primary studies, systematic reviews, and secondary analyses of primary and secondary care datasets. Base case analysis showed that the PSA pathway was dominated by both mpMRI- and bpMRI-based pathways for patients undergoing opportunistic screening and symptomatic assessment. bpMRI pathways had greater improvement in cost and utility than mpMRI pathways in both clinical scenarios. Significantly more MRI scans would be performed using the modelled approach (66 626 scans vs. 37 456 scans per 100 000 patients per annum), with fewer subsequent urgent suspected cancer referrals for both mpMRI (38% reduction for screening and symptomatic patients) and bpMRI (72% reduction for screening; 71% for symptomatic) pathways, and a small increase in number of missed cancer diagnoses. Deterministic sensitivity analyses, varying each parameter to its upper and lower 95% confidence intervals, showed no significant change in the dominance of the MRI-based prostate cancer diagnostic pathways. Using prostate MRI as a second-level triage test for suspected prostate cancer in primary care could reduce health service costs without a detrimental effect on patient utility.

How a population-based cohort of men estimate lifetime risk of prostate cancer in a survey before entering a prostate cancer screening trial in Sweden?

ObjectivesInvestigating men’s perceived lifetime risk of prostate cancer.DesignSurvey-based study to men invited for prostate-specific antigen (PSA) screening in the GÖTEBORG-2 trial between September 2015 and June 2020.Setting38 775 men in...

Sociodemographic and clinicopathologic characteristics of patients treated with high dose rate prostate brachytherapy in Nigeria.

Prostate cancer is the most commonly diagnosed malignancy in adult males. High dose rate brachytherapy (HDRB) recently became available in the country for the management of localized prostate cancer in addition to other treatment modalities. HDRB offers a less invasive option to radical prostatectomy and also has a better side effects profile. To report the socio-demographic features of the patients treated with HDRB, the clinicopathologic pattern of their disease and possible predictors of these features. A retrospective study of patients with histopathologically confirmed prostate cancer, who had HDRB at the Department of Radiation Oncology, University College Hospital, Ibadan, Nigeria, between July 2020 and 2023 was done. Patients' socio-demographic and clinicopathologic characteristics were extracted from their treatment records. A total of 73 patients had HDRB within the period under review. The median age was 66 years (51-78 years). About 40% had prostate cancer diagnosed following routine prostate-specific antigen (PSA) screening. The median screening PSA was 20.5 ng/mL (5.83-75.35 ng/mL). About a quarter (24.7%) were asymptomatic at presentation while frequency (60.3%), nocturia (45.2%) and urgency (35.6%) were the most common symptoms. The median initial PSA was 26.00 ng/mL (5.10-124.50 ng/mL) and the median PSA before brachytherapy was 6.25 ng/mL (0.03-175.30 ng/mL), the majority (75.3%) had androgen deprivation therapy before brachytherapy. Forty-seven patients (64.4%) presented with TNM stages 1 and 2 while grade group 2 (24.7%) and high risk (76.7%) were the commonest grade group and risk group, respectively. There was a significant association between age group and TNM stage (p = 0.043), level of education (LOE) and TNM stage (p = 0.037) as well as PSA screening and grade group (p = 0.007). The majority of the patients who presented for prostate brachytherapy were elderly, had higher initial PSA, were in the high-risk group and had early-stage disease. About 25% of the patients were asymptomatic at presentation. Patients with tertiary LOE and elderly patients presented more with stage 1 and 2 diseases.

PSA screening for prostate cancer in the United States: 30years of controversy.

In 1994, the United States approved the Prostate-Specific Antigen (PSA) test as a screening tool for prostate cancer. It did so despite the test's inherent weakness: not being prostate cancer specific. Subsequent randomized trials yielded conflicting results as to its benefits. Medical guideline organizations are concerned that PSA screening results in the diagnosis and treatment of clinically indolent prostate cancer. Nevertheless, PSA screening is prevalent in North America and Europe with PSA screening increasing in other regions. We provide a critical review of the major factors that led to the prevalence of PSA screening in the United States despite the debate about its benefits. Public advocacy in favor of the test and failure of the medical community to appreciate its inherent weakness led to widespread adoption. These factors persist today. Other countries need to carefully analyze the utility of the PSA test before adopting it.

Prostate-Specific Antigen Screening and Prostate Cancer Mortality: An Emulation of Target Trials in US Medicare.

No consensus about the effectiveness of prostate-specific antigen (PSA) screening exists among clinical guidelines, especially for the elderly. Randomized trials of PSA screening have yielded different results, partly because of variations in adherence, and it is unlikely that new trials will be conducted. Our objective was to estimate the effect of annual PSA screening on prostate cancer (PC) mortality in Medicare beneficiaries age 67-84 years. This is a large-scale, population-based, observational study of two screening strategies: annual PSA screening and no screening. We used data from 537,599 US Medicare (2001-2008) beneficiaries age 67-84 years who had a good life expectancy, no previous PC, and no PSA test in the 2 years before baseline. We estimated the 8-year PC mortality and incidence, treatments for PC, and treatment complications of PSA screening. In men age 67-74 years, the estimated difference in 8-year risk of PC death between PSA screening and no screening was -2.3 (95% CI, -4.1 to -1.1) deaths per 1,000 men (a negative risk difference favors screening). Treatment complications were more frequent under PSA screening than under no screening. In men age 75-84 years, risk difference estimates were closer to zero. Our estimates suggest that under conventional statistical criteria, annual PSA screening for 8 years is highly compatible with reductions of PC mortality from four to one fewer PC deaths per 1,000 screened men age 67-74 years. As with any study using real-world data, the estimates could be affected by residual confounding.

Racial, ethnic, and socioeconomic disparities in rates of stage IV prostate cancer after USPSTF category "D" recommendation against prostate-specific antigen screening: a retrospective cohort study.

In 2012 the United States Preventative Services Task Force (USPSTF) changed its prostate-specific antigen (PSA) screening recommendation to a category "D". The purpose of this study is to examine racial, ethnic, and socioeconomic differences in risk of presentation with metastatic prostate cancer (mPCa) at time of diagnosis before and after the 2012 USPSTF category "D" recommendation. This is a population-based cohort study. We identified patients with mPCa at diagnosis within the National Cancer Database from 2004-2017. Logistic regression models were used to examine associations of mPCa with age, race, ethnicity, geographic location, education level, income, and insurance status. Linear regression models assuming underlying binomial distribution were fitted to annual percentage of mPCa at diagnosis for years 2012-2017 to evaluate the post category "D" recommendation era. From 2004 to 2017, 88,987 patients presented with mPCa. A higher percentage of mPCa was noted post-USPSTF category "D" recommendation, with a disproportionately greater increase observed among Hispanics and non-Hispanic Blacks [Δslope/year: Hispanics (0.0092), non-Hispanic Blacks (0.0073) and non-Hispanic Whites (0.0070)]. Insurance status impacts race/ethnicity differently: uninsured Hispanics were 3.66 times more likely to present with mPCa than insured Hispanics, while uninsured non-Hispanic Blacks were 2.62 times more likely to present with mPCa than insured non-Hispanic Blacks. Household income appears to be associated with differences in mPCa, particularly among non-Hispanic Blacks. Those earning <$30,000 were more likely to present with mPCa compared to higher income brackets. Since the USPSTF grade "D" recommendation against PSA screening, the percentage of mPCa at diagnosis has increased, with a higher rate of increase among Hispanic and non-Hispanic Blacks compared to non-Hispanic Whites.

Impact of Prostate-Specific Antigen Screening Pattern on Prostate Cancer Mortality Among Non-Hispanic Black and Non-Hispanic White Men: A Large, Urban Health System Cohort Analysis.

Randomized studies assessing the effect of PSA screening on mortality in non-Hispanic Black (NHB) men are lacking. We aimed to assess the association between PSA screening and survival among NHB men in comparison to non-Hispanic White (NHW) men in a racially diverse real-world North American population. The study cohort included 6378 men who self-identified as NHB or NHW and were diagnosed with prostate cancer (PCa). Patients received PSA screening and subsequent PCa treatment and follow-up at our institution. Patients were sorted based on PSA testing intensity for the 5 years prior to diagnosis, as follows: never, some (<1 test/y), and annual testing (1 test/y). The primary outcome was risk of prostate cancer-specific mortality (PCSM). Competing risk cumulative incidence curves estimated PCSM rates. Competing risk regression analyses examined the impact of PSA testing on PCSM. An interaction term was incorporated to assess the impact of race on the outcome. Median (IQR) age and PSA at diagnosis were 67 (60-73) years and 5.8 (4.4-9.6) ng/mL, respectively, and 2929 (46%) men were NHB (Kruskal-Wallis P values < .001). Annual PSA testing was more frequent in NHW (5%) than in NHB (3%) men (χ2 P value < .001). On cumulative incidence analysis, in the never, some, and annual PSA testing groups, the 10-year PCSM was respectively 12.3%, 5.8%, and 4.6% in NHW and 18.5%, 7%, and 1.2% in NHB patients (Gray's test P values < .001). At competing risk regression, PSA screening rate was associated with more favorable PCSM rates (HR: 0.47; 95% CI 0.33-0.68; P < .001). The interaction term for race did not show statistical significance (P = .2). PSA testing was associated with a reduced risk of PCSM in both NHB and NHW men diagnosed with PCa. Additionally, the positive impact of the screening rate seemed to be independent of race.

Out-of-pocket costs for diagnostic testing following abnormal prostate cancer screening among privately insured men.

Prostate cancer is the most common malignancy among men and following a positive prostate-specific antigen (PSA) screening test, patients may undergo more expensive diagnostic testing. However, testing-related out-of-pocket costs (OOPCs), which may preclude patients from completing the screening process, have not been previously quantified. OOPCs for follow-up diagnostic testing (i.e., prostate biopsy and/or magnetic resonance imaging [MRI]) in patients with private insurance undergoing prostate cancer screening were estimated. Men ages 55 to 69 years old who underwent PSA-based prostate cancer screening from 2010 to 2020 from the IBM Marketscan database were identified. The number of patients undergoing follow-up diagnostic testing within 12 months of screening was tabulated, dividing patients into three groups: (1) biopsy only, (2) MRI only, and (3) MRI+biopsy. Over the study period, patients with nonzero cost-sharing and calculated inflation-adjusted OOPCs, adding copayment, coinsurance, and deductible payments, for each group were identified. Among screened patients (n=3,075,841) from 2010 through 2020, 91,850 had a second PSA test and an elevated PSA level, of which 40,329 (43.9%) underwent subsequent diagnostic testing. More than 75% of these patients experienced cost-sharing, and median OOPCs rose substantially over the study period for patients undergoing biopsy only ($79 to $214), MRI only ($81 to $490), and MRI and biopsy ($353 to $620). OOPCs from diagnostic testing after prostate cancer screening are common and rising. This work aligns with the recent position statement from the American Cancer Society, that payers should eliminate cost-sharing, which may undermine the screening process, for diagnostic testing following cancer screening.

Editorial Comment: Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System

Editorial Comment: Reductions in Prostate-Specific Antigen Screening During the COVID-19 Pandemic in a Universally Insured American Health System

Comparative Trends in the Distribution of Prostate Cancer Stage at Diagnosis in the Department of Defense Cancer Registry and the Surveillance, Epidemiology, and End Results Data, 2004-2014.

It has been demonstrated that there was an increase in later-stage prostate cancer (PCa) at diagnosis after the U.S. Preventive Services Task Force recommended against prostate-specific antigen screening for prostate cancer. However, the cancer characteristics at diagnosis within the equal-access Military Health System (MHS) during the period have not been described. In this study, we compared PCa stage at diagnosis and its trends between the military health care system and the general public and further compared the trends in tumor stage by race. This study was based on nonidentifiable data from the U.S. Department of Defense's Central Cancer Registry (CCR) and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Patients diagnosed between 2004 and 2014 were included. The distributions of PCa stage at diagnosis over time were compared between the 2 populations. Comparisons were further conducted for White and Black patients, respectively. Among the 11,895 patients in the CCR and 544,142 patients in SEER, the majority of patients were diagnosed with stage I or II prostate cancer. However, the CCR had a larger proportion of early-stage tumors (stages I and II combined) with 84.3% vs. 80.0% of SEER patients. The proportion of late-stage tumors (stages III and IV combined) increased over time from 2008 for both populations and the proportion of early-stage tumors decreased for the general population. In terms of temporal distributions by race, the trends were the same between White and Black groups in the general population. In the MHS, the trends in the White patients were similar to those in the general population, but in the Black patients, the percentages of stages I and II at diagnosis continued to increase and those of stages III and IV decreased, differing from those in the general population. The MHS consistently diagnosed PCa at an earlier stage than the U.S. general population across all time periods evaluated in this study. Although similar trends were observed for White patients between both populations, the proportion of stages I and II at diagnosis increased from 2012 among Black patients in the MHS, which stands in sharp contrast to trends in the U.S. general population. Although the differences between the two populations may be associated with various factors, differences in accessibility to care and thus the use of prostate-specific antigen testing might play an important role.